Healthcare Provider Details

I. General information

NPI: 1700286721
Provider Name (Legal Business Name): NANNETTE NERO ZUKE, LMFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 PORTLAND RD SUITE 6
KENNEBUNK ME
04043-6650
US

IV. Provider business mailing address

3 BOYNTON BROOK RD
SACO ME
04072-9379
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-5580
  • Fax:
Mailing address:
  • Phone: 207-985-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF1940
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NANNETTE A. NERO ZUKE
Title or Position: SOLE MEMBER, MGR, OWNER
Credential: MS, CAGS, LMFT
Phone: 207-985-5580